Reason Magazine - WHO Cares?:
"Paul Dietrich was visiting Mozambique's capital city, Maputo, during its civil war in 1984, when an educational billboard taught him a lesson he never forgot.
Paul Dietrich was visiting Mozambique's capital city, Maputo, during its civil war in 1984, when an educational billboard taught him a lesson he never forgot.
Dietrich, a former publisher of the old weekly Saturday Review, was in Africa working with a Catholic charity. He was driving in his Land Rover, the only working motorized vehicle for miles. Poverty-stricken people surrounded him, most of them on foot, though a lucky few rode oxen. The billboard was the only one he'd seen in all Mozambique. Though most of the chaotic, war-torn country was plagued by regular power outages, the sign had its own electrical supply. This billboard was paid for by the World Health Organization (WHO), the international bureaucracy created, in the words of its constitution, to "promote and protect the health of all peoples."
It urged the people of Mozambique to remember to buckle their seatbelts.
It also helped cement Dietrich's doubts about WHO's vision and mission. After seeing that billboard, and contemplating what it said about WHO's priorities and goals, he became one of WHO's most vocal critics. In the early 1990s, Dietrich served on the development committee of the Pan American Health Organization (which functions as an American branch office for WHO). He has also been president of the Institute for International Health and Development. Dietrich wrote about WHO frequently for The Wall Street Journal, and provided material for exposés of WHO shenanigans on 60 Minutes and various TV documentaries in Europe (where WHO's activities are minded far more closely than in the United States, even though the U.S. provides 22 percent of the organization's regular budget).
Dietrich publicly and repeatedly complained that WHO was a bureaucracy for bureaucracy's sake, mired in useless statement-making and conference-giving. He thought it focused too much on First World concerns -- such as seatbelt campaigns and smoking -- and not enough on the developing world's sick and poor.
For his troubles, Dietrich became the target of a WHO-sponsored investigator who dug into his and his wife's background, finances, and politics. Dietrich only learned of the investigation when a mole in WHO's Geneva headquarters faxed him a copy of the final report. WHO singled out Dietrich, now an investment banker, in an August 2000 report that received heavy play in the New York Times and Washington Post. The report, dedicated to the tobacco industry, claimed Dietrich's motives were purely mercenary. He was named as a paid agent in a sinister international tobacco industry scheme to discredit WHO. The truth, Dietrich tells me, is far less sexy: A law firm he had worked for did work for tobacco companies, along with almost every other Fortune 500 company.
...But WHO's agenda is more ambitious than merely bringing medical care to the world's disadvantaged. Health, in a definition the group adopted over 20 years ago, is "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." That is a totalist vision, and an alarming one. Armed with a bureaucrat's mentality, an arsenal of questionable data and conclusions, and a billion dollars in taxpayer money donated by governments around the world, WHO's goal seems not so much to bring the world "health" as a physical condition as it is to bring the world under the control of the international mavens of "public health," the sociopolitical discipline.
But WHO is more an organization fighting for its life than one fighting for real power. As curable infectious diseases become a less significant factor in world mortality rates, WHO's budget has stagnated at around $1 billion a year for nearly a decade now. Various other huge bureaucracies -- such as the U.S. Centers for Disease Control and the World Bank, whose budget on international health matters is slightly higher than WHO's -- have poached on its turf.
Why, to borrow Paul Dietrich's question, is WHO concerned with seatbelts and smoking when the world's poor are still dying of measles and tuberculosis? Public choice analysis -- which presumes that government agencies, like their private-sector counterparts, seek to grow their market share -- suggests an answer: Since the WHO's funding is mostly from First World governments, making them its relevant "customer base," it caters to First World concerns. WHO's recent history has been a vivid example of bureaucratic mission creep. In expanding its purview far beyond the merely medical, WHO is trying to stave off extinction.
...WHO's main success story remains its role in eradicating smallpox. Sometimes, though, it seems to believe the world will be impressed with the sort of thing that really occupies it these days. One WHO propaganda book lists five things we'd be missing in "A World Without WHO" -- presumably what it considers its most important achievements. None of them had to do with curing a single disease in a single person. Instead, they aver that in "a world without WHO -- national health officials would not be able to count on global moral support in their battle against tobacco addiction," and "there would be no unifying moral and technical force to galvanize, guide and support countries in achieving health for all by the year 2000."
By the end of the 1970s, WHO's official rhetoric about its core purpose began to shift from simple disease eradication. In 1978, at a joint meeting of WHO and UNICEF in Kazakhstan, in the former Soviet Union, WHO adopted "World Health for All by 2000" as its goal. This conclave of international bureaucrats vowed that, by the close of the 20th century, "All governments will have assumed overall responsibility for the health of their people -- through influencing lifestyles and controlling the physical and psychosocial environment." An "equitable distribution of health reserves, both among countries and within countries -- is therefore fundamental to the strategy." This plan was "part of that fundamental reorganization of human relationships in the world through the search for a New International Economic Order."
Meet the New Boss
By the mid-1990s, WHO was mired in what the British Medical Journal called "a morass of petty corruption and ineffective bureaucracy." Under Director General Hiroshi Nakajima, a Japanese pharmacologist, WHO was so widely understood to be mired in cronyism and financial irregularities that such longtime boosters as Denmark and Sweden slashed their contributions; even the group's official auditor resigned in disgust. Nakajima's prominent position was important to Japanese self-esteem, so Japan embarked on a campaign in 1993 to make sure he was re-elected to a second five-year term. Among other gambits, the Maldives and Jamaica were warned that Japan would stop importing anything from them if Nakajima didn't get their vote.
Nakajima got his second term, but in 1998, with WHO morale and reputation at an all-time low, he was replaced by Gro Harlem Brundtland. With a masters in public health, Brundtland had spent most of her career as a politician, serving three terms as prime minister of Norway. She had also founded and led the UN's World Commission on Environment and Development. As WHO's new head, she promptly announced such vital-to-health goals as ensuring that six of every 10 new hires would be women.
In a world still fighting infectious disease, Brundtland's WHO has issued statements, studies, and reports on such topics as blood clots in people who sit still on airplanes too long, helping people remain active while aging, the hazards of using cell phones while driving, the importance of debt relief for poor countries, how tobacco is "a major obstacle to children's rights," and rates of alcohol abuse among European teens. The Lancet, the respected British medical journal, summed up her priorities thusly: "Brundtland has so far set out a conspicuously political agenda: her targets are poverty, underdevelopment, and social inequality."
...In its war on tobacco, WHO has attempted Orwellian moves of almost absurd incompetence. In 1998, for instance, the group was supposed to release an enormous 10-year study on second-hand smoke's links with lung cancer, the largest ever done in Europe. A small mention of it was printed in a WHO report before the whole study was available. The British Sunday Telegraph tried to get a copy of the study, since the brief reference intriguingly implied that it could not find a statistically significant link between second-hand smoke exposure and lung cancer. The Telegraph implied that WHO was trying to bury the report since its results went against their official anti-tobacco stance.
WHO and other anti-tobacco groups were outraged. One group, Action on Smoking and Health, filed an official complaint with Britain's Press Complaints Commission over the supposedly erroneous reporting. (The commission found in the Telegraph's favor.) WHO responded to reports that its study did not find a statistically significant link between second-hand smoke and lung cancer in a press release headlined, "Passive Smoking Does Cause Lung Cancer, Do Not Let Them Fool You" -- strange, strained language from a supposedly scientific organization.
Underneath that colorful headline, the press release states, in italics, that "passive smoking causes lung cancer in non-smokers." Then, in the very next paragraph, it clarifies, "The study found that there was an estimated 16% increased risk of lung cancer among non-smoking spouses of smokers. For workplace exposure the estimated increase in risk was 17%. However, due to small sample size, neither increased risk was statistically significant." In other words, the Telegraph report was exactly correct: The study had found no statistically significant link between second-hand smoke and cancer.
...The study relied on a bit of numerical chicanery, originally developed by the World Bank: the "disability adjusted life year" (DALY). This is a complicated bit of scientism designed to quantify the effects of illnesses in terms of years of life lost. The DALY is based on the principle that a year living with certain conditions isn't really like a year of living. It allows WHO to make a big deal about "unipolar major depression," which it predicts will be the number two cause of "disease burden" by 2020, even though the ailment is not known to kill many people.
DALY is not objectively verifiable -- WHO came up with its numbers by asking a bunch of health workers how much they thought certain ailments reduced the value of a year of their life. So now science has demonstrated that below-the-knee amputation is somewhere from 0.22 to 0.36 "severity weights" more terrible than vitiligo (the "whitening" disease famously suffered by Michael Jackson) on your face. A small group of people's raw opinions were transformed through WHO's alchemy into hard public-health science.
...Nothing condemns WHO's current agenda more than some of its own pronouncements. In a 1999 press release, WHO declared that six illnesses accounted for 90 percent of all infectious disease deaths among people under 44 years: malaria, tuberculosis, measles, diarrheal diseases, acute respiratory infections (including pneumonia), and AIDS. The same press release declared that "the tools to prevent deaths from each of these six diseases now cost under $20 per person at risk, and in most cases under $0.35. Yet these diseases still caused over 11 million deaths in 1998."
...Wagner and Tollison's analysis of WHO's budget in the mid-'90s found the group's spending heavily weighted toward conferences and headquarters expenses and away from actual on-the-ground aid in disease-fighting. They noted 70 percent of the budget then went to administrative overhead and the Geneva headquarters. In 1995, Tollison observed on British TV that "the World Health Organization is famous for its conferences, but I think that any ordinary person complying with a decision to spend on those conferences or to spend on senior executives in Geneva versus looking at real public health problems in the field, where little children are dying for want of a shot, I don't think anybody would make any other decision than to say, get the resources out of Geneva, quit having the conferences. Inoculate those children.""
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